Health Plan Review

In order to ensure that insurance rates are fair to consumers and that insurance carriers stay financially healthy, OHIC reviews the prices that insurance carriers set and the plans that they create through the form and rate review process. Insurers in the state must submit information on plan benefits and plan rates annually. OHIC then reviews all proposed rates to determine if health insurance companies are proposing unreasonable rates.

OHIC also uses the rate review process to monitor insurer solvency. Insurers must be able to stay in business and pay all their customers' health expenses. An insurance company going out of business hurts the entire health care system. OHIC uses criteria to approve plans that ensure that prices are fair for both insurers and consumers.

For the individual and small group market, OHIC examines the details of each health plan, which the insurers share with OHIC in documents known as "forms." These documents include all of the information about what the plan covers, the plan’s network, and member cost sharing structure (what the co-pays and deductibles are). OHIC must make sure the plans follow all state and federal laws. And when an insurer claims that consumers will only be responsible for a set percentage of their health costs, OHIC can use these documents to make sure the insurer's claims are true.

Health Plan Review Documents

Here you will find a listing of all documents related to OHIC's form and rate review process. For the individual (direct pay), small group, and large group markets, insurers submit proposed rates for each of their plans in their annual rate filings. Once all rates have been submitted, OHIC hears public comment on the rates. Consumers and small employers are invited to submit their input on the rates. The commissioner considers the input, along with actuarial and other data. Then the Commissioner issues a legally-binding decision and sets the rates for the coming year.

OHIC generally requires insurers to submit their proposed rates for individual (direct pay), small group, and large group plans in May. The process for Medicare Supplement Plans, also referred to as Medigap plans, generally begins later in the summer. Definitions for key abbreviations can be found here.

2017 Process and Documents

On August 17, 2017, Health Insurance Commissioner Marie Ganim, PhD announced her final decision on commercial health insurance premiums for 2018. She approved lower rates than those requested by most health insurers. The rising cost of medical care - the prices insurers pay to providers for particular services and the number of services members use - continues to be the main driver of health insurance premium growth. Also, the reinstatement of the federal health insurance tax adds up to 2% to premiums in some markets.

Blue Cross Blue Shield of Rhode Island (BCBSRI), Neighborhood Health Plan of Rhode Island (NHPRI), Tufts Health Plan (Tufts), and United Healthcare (United) filed with the State of Rhode Island Office of the Health Insurance Commissioner (OHIC) to request approval for rates to be charged to individuals, small employers, and large employers effective in 2018.

BCBSRI and NHPRI have filed in the individual market. All four commercial health insurers have filed in the small employer market. BCBSRI, Tufts, and United have filed in the large employer market. OHIC has the responsibility of reviewing the rates with the goal of holding the insurers publicly accountable for making health insurance more affordable while ensuring their solvency.As a part of its review of the rates filed, OHIC is soliciting public comment on what has been submitted by the insurers. OHIC believes that public input is essential and will take all input received into account in developing its final decision. All public comments must be received by OHIC by July 27, 2017. There will also be a public input meeting on June 18, 2017 at 5:30pm at the State of Rhode Island Public Utilities Commission (89 Jefferson Boulevard, Warwick).

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For public access to the form and rate filings submitted on May 12, 2017 and June 16, 2017, please use the link below and enter in the SERFF Tracking numbers to access the filing. These submissions are currently under review by OHIC and are subject to change as the review process continues. Insurers filing in the individual and small group market are required to file a consumer disclosure form explaining their proposed rate increases. For access to the federal website on rate review, please visit: https://ratereview.healthcare.gov/.

For public access to BCBSRI's individual market form and rate filing submitted on June 16, 2017, please use the link below and enter in the SERFF Tracking number to access the filing. Insurers filing in the individual and small group market were required to file a consumer disclosure form explaining their proposed rate increases (please see above).

Blue Cross Direct Pay Hearing:
2017 BCBSRI Direct Pay hearings will be held July 20th and 21st, 2017 at 9:00 a.m. On July 20th, 2017 at 6:00 p.m. and July 21st, 2017 at 9:00 a.m. will be heard public comment at the Rhode Island Public Utilities Commission Hearing Room 89 Jefferson Blvd. Warwick, Rhode Island.

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2016 Process and Documents

On August 11, 2016, Health Insurance Commissioner Kathleen C Hittner, MD announced her final decision on commercial health insurance premiums for 2017. She approved lower rates than those requested by most health insurers. The rising cost of medical care - the prices insurers pay to providers for particular services and the number of services members use - continues to be the main driver of health insurance premium growth.

On May 13, 2016, Blue Cross Blue Shield of Rhode Island (BCBSRI), Neighborhood Health Plan of Rhode Island (NHPRI), Tufts Health Plan (Tufts), and United Healthcare (United) filed with the State of Rhode Island Office of the Health Insurance Commissioner (OHIC) to request approval for rates to be charged to individuals, small employers, and large employers effective in 2017.

BCBSRI and NHPRI have filed in the individual market. All four commercial health insurers have filed in the small employer market. BCBSRI, Tufts, and United have filed in the large employer market. OHIC has the responsibility of reviewing the rates with the goal of holding the insurers publicly accountable for making health insurance more affordable while ensuring their solvency.

As a part of its review of the rates filed, OHIC is soliciting public comment on what has been submitted by the insurers. OHIC believes that public input is essential and will take all input received into account in developing its final decision. All public comments must be received by OHIC by June 27, 2015. There will also be a public input meeting on June 22, 2016 at 5:30pm at the State of Rhode Island Public Utilities Commission (89 Jefferson Boulevard, Warwick).

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For public access to the form and rate filings submitted on May 13, 2016, please use the link below and enter in the SERFF Tracking numbers to access the filing. These submissions are currently under review by OHIC and are subject to change as the review process continues. Insurers filing in the individual and small group market are required to file a consumer disclosure form explaining their proposed rate increases. For access to the federal website on rate review, please visit: https://ratereview.healthcare.gov/.

For public access to BCBSRI's individual market form and rate filing submitted on May 13, 2016, please use the link below and enter in the SERFF Tracking number to access the filing. Insurers filing in the individual and small group market were required to file a consumer disclosure form explaining their proposed rate increases (please see above).

Essential Health Benefits Benchmark Plan 2017

The Office of the Health Insurance Commissioner (OHIC) is seeking public comment on the selection of the state’s essential health benefits (EHB) for 2017. Beginning in 2014, the federal Affordable Care Act required health plans sold in the individual and small group markets to offer a comprehensive package of items and services, known as “essential health benefits.” Rhode Island chose a benchmark plan in 2012 for use in the 2014-2016 plan years. The federal government now requires that all states choose a new benchmark plan, for use in plan year 2017, by July 1, 2015.